Reference : Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethic...
Scientific journals : Article
Human health sciences : Neurology
http://hdl.handle.net/2268/111561
Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
English
Demertzi, Athina mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Racine, Eric [> >]
Bruno, Marie-Aurélie mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Ledoux, Didier [> >]
Gosseries, Olivia mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Vanhaudenhuyse, Audrey mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Thonnard, Marie mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Soddu, Andrea mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
MOONEN, Gustave mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie Sart Tilman >]
Laureys, Steven mailto [Université de Liège - ULg > > Centre de recherches du cyclotron >]
2013
Neuroethics
Springer
6
1
37-50
Yes
1874-5490
[en] Pain ; End-of-life ; Vegetative state ; Minimally conscious state ; Ethics ; Attitudes ; Survey
[en] Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain
<br />which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain
<br />perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional
<br />background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for
<br />treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.
http://hdl.handle.net/2268/111561
also: http://hdl.handle.net/2268/157928
10.1007/s12152-011-9149-x
http://reflexions.ulg.ac.be/ethiquevieetmort

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